Valoración del dolor de tobillo: síndrome del impacto posterior del tobillo secundario a proceso de Stieda / Assessment of ankle pain: posterior ankle impingement syndrome secondary to a Stieda process

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[Management of time used to treat the chronic patient: a new approach to improve quality of health care]. / Gestión del tiempo de asistencia al paciente crónico: un nuevo enfoque para mejorar la calidad asistencial.

OBJECTIVE: Chronic disease is the main epidemic of the 21st century. It takes up a large part of the social-health budgets that are dedicated to its care. The aim of this study is to analyze if the welfare quality in the management of the chronic patients improves by implementing non-contact care time. MATERIAL AND METHODS: Intervention study conducted in the health care center of Orcasitas (January 2012 - September 2013) in patients with hypertension (357), diabetes (180) and/or ischemic heart disease (60). Health care quality was analyzed through the effectiveness in the program, Tracking Objectives in Primary Care. The intervention group had four physical 10minute consultations/year and three non-physical 10minute consultations/year. The patients in the control group were seen as usual. The data were compared using the McNemar test, chi-square and Cochran's Q test. RESULTS: In the intervention group, the effectiveness increased in the analyzed period by 46%, 54% and 55.9%, respectively, for processes of hypertension, diabetes and dyslipidemia control in ischemic heart disease, whereas in the control group (community of Madrid) it was 2.54%, 1.78%, and 5.44%, respectively, for these processes (statistically significant differences [χ(2)=24.78; χ(2)=39.9 y χ(2)=67.3, P<.0001]). CONCLUSIONS: Thirty minutes/year of non-presential care represents a significant change in the level of control of chronic patients. These results should be considered in the approach strategies to chronic diseases.

Gestión del tiempo de asistencia al paciente crónico: un nuevo enfoque para mejorar la calidad asistencial / Management of time used to treat the chronic patient: A new approach to improve quality of health care

Objetivo. La cronicidad es la principal epidemia del siglo XXI y condiciona que gran parte de los presupuestos sociosanitarios se dediquen a su atención. El objetivo de este estudio es analizar si la calidad de la atención al paciente crónico mejora implantando tiempos asistenciales no presenciales. Material y métodos. Estudio de intervención realizado en el centro de salud de Orcasitas (enero de 2012-septiembre de 2013) en pacientes con hipertensión (357), diabetes (180) y/o cardiopatía isquémica (60). La calidad asistencial se analizó mediante la efectividad reflejada en el programa de seguimiento de objetivos en atención primaria (eSOAP). Para el grupo de intervención se establecieron 4 consultas presenciales y 3 no presenciales por año, de 10 min cada una, manteniendo el grupo control su dinámica habitual. Los datos se contrastaron mediante las pruebas de McNemar, Chi-cuadrado y Q de Cochran. Resultados. En el grupo de intervención la efectividad se incrementó en el periodo analizado un 46%, un 54% y un 55,9% respectivamente para los procesos hipertensión, diabetes y control de la dislipidemia en cardiopatía isquémica, mientras que en el grupo control (Comunidad de Madrid) fue, respectivamente, del 2,54%, 1,78% y 5,44% (diferencias estadísticamente significativas [χ2 = 24,78; χ2 = 39,9 y χ2 = 67,3, p < 0,0001]). Conclusiones. Treinta minutos/año de atención no presencial suponen un cambio relevante en el grado de control del paciente crónico. Este resultado debería ser tenido en cuenta en las estrategias de abordaje de la cronicidad (AU)

Objective. Chronic disease is the main epidemic of the 21st century. It takes up a large part of the social-health budgets that are dedicated to its care. The aim of this study is to analyze if the welfare quality in the management of the chronic patients improves by implementing non-contact care time. Material and methods. Intervention study conducted in the health care center of Orcasitas (January 2012 - September 2013) in patients with hypertension (357), diabetes (180) and/or ischemic heart disease (60). Health care quality was analyzed through the effectiveness in the program, Tracking Objectives in Primary Care. The intervention group had four physical 10 minute consultations/year and three non-physical 10 minute consultations/year. The patients in the control group were seen as usual. The data were compared using the McNemar test, chi-square and Cochran's Q test. Results. In the intervention group, the effectiveness increased in the analyzed period by 46%, 54% and 55.9%, respectively, for processes of hypertension, diabetes and dyslipidemia control in ischemic heart disease, whereas in the control group (community of Madrid) it was 2.54%, 1.78%, and 5.44%, respectively, for these processes (statistically significant differences [χ2 = 24.78; χ2 = 39.9 y χ2 = 67.3, P < .0001]). Conclusions. Thirty minutes/year of non-presential care represents a significant change in the level of control of chronic patients. These results should be considered in the approach strategies to chronic diseases (AU)

Urticaria de contacto por Aloe vera / Contact urticaria by Aloe vera

El Aloe vera es un producto ampliamente usado en alimentación y cosmética. Aunque es considerado una planta medicinal por sus múltiples propiedades, no es un producto inocuo, ya que presenta ciertos componentes irritantes que pueden producir efectos secundarios. La dermatitis alérgica de contacto se presenta entre los mismos. Presentamos el caso de un niño de seis años en el que observamos una urticaria tras la aplicación directa del jugo de la planta de Aloe, con buena respuesta al tratamiento convencional de la urticaria. Tras esta revisión bibliográfica, podemos concluir que no puede recomendarse el uso de Aloe vera para el tratamiento de ninguna patología específica debido a que no existe suficiente evidencia de su eficacia en la práctica clínica (AU)

Aloe vera is a widely used product in the food sector and the cosmetics industry. Although it is considered to be a medicinal plant because of its many properties, it is not an innocuous product as it has certain irritating components which can cause side effects. Allergic contact dermatitis is included among them. We present the case of a six-year-old child who shows urticaria after applying the juice of the Aloe plant directly onto the skin. The patient responded successfully to conventional urticaria treatment. After this literature review we can conclude that the use of Aloe vera cannot be recommended for the treatment of any specific pathology since there is not enough evidence to prove the effectiveness in clinical practice (AU)

[Small cell-sarcomatoid carcinoma of the urinary bladder]. / Carcinoma de célula pequeña-sarcomatoide de vejiga urinaria.

OBJECTIVES: Oat cell carcinoma of the urinary bladder is extremely uncommon. To date, 87 cases have been reported in the literature. Histologically, these tumors are similar to oat cell carcinoma of the lung and in slightly more than half of the cases the tumor is associated with another carcinomatous component: urothelial, squamous carcinoma, adenocarcinoma or, more rarely, sarcomatoid carcinoma. A case of sarcomatoid small cell carcinoma is described herein. METHODS/RESULTS: We report a case of sarcomatoid small cell carcinoma of the urinary bladder in a 79-year-old female patient. The tumor was in the advanced stages and was unamenable to resection. The patient was treated with multi-drug systemic chemotherapy, but she died five months after diagnosis. Light microscopy disclosed a carcinomatous component similar to oat cell carcinoma of the lung that stained with epithelial and neuroendocrine markers. The sarcomatoid component was histologically nondescript and showed extensive immunoreactivity to mesenchymal and epithelial markers. CONCLUSIONS: Sarcomatoid small cell carcinoma of the bladder is rare. To our knowledge, only five cases have been previously reported. It is aggressive, metastasizes early and has a poor diagnosis. Surgical resection with adjuvant multidrug systemic chemotherapy is currently the best available treatment.

[Well-differentiated liposarcoma of the spermatic cord with dedifferentiation]. / Liposarcoma bien diferenciado de cordón espermático con desdiferenciación.

We report a case of well-differentiated liposarcoma with dedifferentiation of spermatic cord in a 73-year-old-man. Treatment was by orchiectomy without retroperitoneal lymph node dissection or adjuvant therapy. The patient has survived 10 months with no evidence of recurrence. Liposarcoma localized to the spermatic cord is rare; less than 70 cases have been previously reported. The literature is reviewed with special emphasis on the clinical significance of the dedifferentiation phenomenon.